背景:关于髋臼肿瘤切除术后最佳骨盆带重建的争论仍然存在,外科医生在模块化和3D打印的半骨盆假体之间挣扎。我们假设3D打印版本的结果更好,然而,缺乏比较研究。这项研究填补了这一空白,回顾性检查生物力学和临床结果。
方法:从2017年2月至2021年6月,我们回顾性评估了32例因髋臼周围恶性肿瘤而接受整块切除术的患者。
方法:肢体功能。
结果:植入物精度,髋关节旋转中心恢复,假体-骨整合,和并发症。通过有限元分析对骨盆缺损模型进行生物力学特性评估。
结果:在3D打印组中,应力分布反映了正常的骨盆,与整体压力升高的模块化组形成对比,不稳定的过渡,和更高的应力峰值。3D打印组表现出优异的功能评分(MSTS:24.3±1.8vs.21.8±2.0,p<0.05;HHS:79.8±5.2vs.75.3±3.5,p<0.05)。假体-骨界面骨整合,用T-SMART测量,受青睐的3D打印假体,但手术时间(426.2±67.0vs.301.7±48.6min,p<0.05)和失血量(2121.1±686.8vs.1600.0±505.0ml,p<0.05)更高。
结论:3D打印的半骨盆内假体提供了精确的骨盆环缺损匹配,优越的应力传递,和功能相比,模块化内置假体。然而,复杂性,制造专业知识,具有挑战性的手术植入导致手术时间延长和失血增加。对功能结果的细微差别考虑,复杂性,和病人的情况是至关重要的明智的治疗决定。
方法:三级,治疗性研究(回顾性比较研究)。
BACKGROUND: Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively.
METHODS: From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution.
METHODS: limb function.
RESULTS: implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models.
RESULTS: In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher.
CONCLUSIONS: The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions.
METHODS: Level III, therapeutic study (Retrospective comparative study).